Thank you very much for inviting me to your conference. I’d like to begin by congratulating all those who have helped to make it a success. I have been impressed by your enthusiasm and dedication to improving services for patients, particularly through your support of practice based commissioning policy and implementation.
With the recent changes in the Ministerial team and at the top of Government, it is inevitable that people ask if the Government’s commitment to practice based commissioning still stands, and if the direction of travel is the same. I want to make it absolutely clear that practice based commissioning is here to stay. We remain as committed as ever to successful implementation. If anything, in the context of my colleague, Lord Darzi’s review, I would expect our commitment to become stronger and the speed of travel quicker. Ara’s interim report was published this month and sets out a vision for an NHS which will deliver effective, higher quality services that are safe, personalised to individual needs, and equally available to all. The report emphasises the need for practice based commissioners to use NHS funds more flexibly and to find alternatives to traditional NHS provision. You are the people who will help us deliver this vision.
It will require better collaboration between Primary Care Trusts, GPs and other health professionals. It is about better clinical engagement and better services for patients. It is about a better use of Primary Care Trust resources. We want to see GPs working with other primary care professionals. We want to see GPs and other primary care professionals having constructive relationships with their Primary Care Trust, hospitals, social services and other local organisations. We want to see front line clinicians leading the design and commissioning of services on behalf of their patients, with their patients.
It will create greater flexibility for practices to innovate and design services, with more decisions being made at practice – not Primary Care Trust – level. Those in the best position to make decisions – GPs – will be able to make those decisions. Where practices free up resources through more effective commissioning, they will be able to reinvest at least 70% of these resources into local patient care.
As many of you know, these are not just aspirations. There are already plenty of practice based commissioners working successfully on the ground. In Hartlepool, a nurse-led Community Respiratory Assessment and Management Service provides a new walk-in facility for patients. This has reduced emergency admissions and the number of consultations required.
In Waltham Forest, a practice based redesigned patient pathway to run a carpal tunnel service has saved £93,000 and significantly reduced waiting times.
In West Kent, GPs have redesigned the pathway and specification of a Deep Vein Thrombosis service. Previously, patients had to wait at least two weeks for ultrasound scans while having daily injections. By introducing immediate screening in the GP surgery, this has resulted in fewer scans and admissions for Deep Vein Thrombosis, improved the patient experience and produces yearly savings of £300,000. These savings can go straight back into reinvestment in patient care.
And very soon I am planning a visit to Havering soon to visit Dr Deshpande, a GP with Special Interests in Urology. What he has achieved via practice based commissioning is truly revolutionary. Dr Deshpande persuaded his local practice based commissioning consortium to invest in technology. A new diagnostic service for patients with suspected benign prostatic hyperplasia was set up using this technology. Diagnostic tests are now taken in the surgery and scans are transmitted down an ISDN (Integrated Services Digital Network) line to a radiologist who looks at the scans in real time: all this while the patient is being examined. The service has cut waiting times from at least 30 weeks to around 4 weeks. For every 200 patients seen, the service saves £62,000. Across a single Primary Care Trust with sixteen practices this would amount to almost £1 million. Money that can be reinvested in more and better services for local people.
But we are under no illusion that practice based commissioning is a roaring success across the whole country yet. We know that in some places, arrangements for practice based commissioning need improving and strengthening. Commissioning should not be a struggle between Primary Care Trusts wanting to hold onto their commissioning role and practice based commissioners wanting to take it away from them. Primary Care Trust commissioning should be based on supporting practice based commissioning, and practice based commissioners should be fully involved in local strategic planning, including local development plans and Local Area Agreements.
But we know that there are still barriers to overcome. Timely, high quality information is crucial to successful, practice based commissioning and is an area which needs further development. We are therefore establishing a Primary Care Trust-led demonstration project in each Strategic Health Authority to focus on how Trusts and practices can make effective use of information to deliver measurable commissioning outcomes. These projects will produce models of best practice relating to the provision of information to practices and these models will then be rolled out to other Primary Care Trusts and practices.
What can you do to help make all this a success? Well, I can only echo the advice of Hartlepool’s Professional Executive Committee Chair and practice based commissioning lead: “look at what’s going on, look carefully at data, identify problems, decide what can be done differently and then get on with it!” We want to encourage practices to ask the Primary Care Trust for support with practice based commissioning – you must be proactive in doing this.
Commissioning is not a hierarchy going down from the Department of Health down to practice based commissioning at the lowest level. In a decentralised NHS, it is the other way round. NHS commissioning must be a product of all those individual meetings between the frontline clinician and his or her patient. Lord Darzi’s report reaffirmed the importance of service redesign being a bottom up approach, and the importance of clinicians being at the forefront of service redesign. And we are serious about encouraging you – front line practitioners and managers – to lead the way towards effective commissioning.
Lord Darzi’s report also recommended the appointment of a primary care advisory board that will help develop future strategy on primary care. The board will includes GPs, community nurses and other health and care professionals. Today, I am pleased to announce that James Kingsland, your chairman, has agreed has agreed to sit on this board. We value his personal contribution and the recommendations that he will no doubt bring to the table.
While we want to encourage you, your feedback has also been encouraging us. The first results of a quarterly practice survey, undertaken on behalf of the Department of Health by IPSOS Mori, will be published at the end of this month. It will show that some things are going well, and other things still require work. Encouragingly, the response rate to the survey has been much higher than we anticipated. Nearly 1,200 out of 2,000 practices surveyed replied: a response rate of around 60%. This demonstrates that there is a good level of interest in practice based commissioning amongst practices and that they are keen to share their views. And the survey also confirms that support for practice based commissioning as a policy remains strong among GPs. The survey does highlight a number of areas where frustrations remain, and we are committed to addressing those.
Service redesign is no longer a minority sport. The survey suggests that practices are beginning to commission new services through practice based commissioning: it shows that a third of practices have commissioned one or more new services. So this is a very good result, considering that practice based commissioning represents a major cultural shift for both practices and Primary Care Trusts – and cultural shifts, as we all know in the health service, can be slow to take effect.
I really want to make sure that practice based commissioning continues to develop and I want to encourage all parts of the NHS to support it. The programme of work to develop World Class Commissioning that we’ve instigated will establish practice based commissioning as the key route for effective clinical engagement. We are developing jointly with NHS partners, including front line clinicians, a vision for World Class Commissioning, an assurance framework to hold commissioners to account, and a support & development framework to provide the tools to achieve world class status.
The most important thing is that we, together, communicate and celebrate what is positive in practice based commissioning. I know that the Secretary of State has already met some practice based commissioners around the country and was highly impressed by their work. He is as keen as I am to get out and see more great examples of practice based commissioning in action.
Without good and widespread practice based commissioning, we will not be able to achieve the clinician led, patient centered, high quality and value for money health care which we all believe in – and which the public expects.
I am happy to take any questions now. (MS (H) may like to say this, or let the panel introduce the formal Q&A.)
Thank you.
